Your First Name

Your Last Name

Your Nickname

Your Birthday

Your Email (required)

Marital Status

Your primary phone #

School Address

City, State, Zip

Home Address

City, State, Zip

General Health

Are there any health related issues that we should be aware of? If so, what are they?

Are there any dietary issue that we should be aware of?

Do you have certifications in any of the following? If so, please note the expiration date; if not, leave blank.
Are you certified in CPR?

Are you certified in First Aid?

Are you a certified Life Guard?

Educational History
Please enter all of the schools that you have attended since grade school. Beginning with high school, please include the name, number of years attended, GPA and major/degree.

School #1

School #2

School #3

Please list your three most recent employers:

Most Recent Employer

Next Most Recent Employer

Third Most Recent Employer

Please list 3 references below: (One must be from a pastor or youth pastor.)
Try to list people who know about your work with youth.
Make sure each reference receives a form or link to the online reference form and understands they are to send it electronically or mail it to Gigi Gibson as soon as possible.
Once you finish the form please e-mail the form, produce hard copies or send the link to the online form to your three references.

Reference #1

Reference #2

Reference #3

Church Involvement:

How often do you attend church?

Home church affiliation:

How long have you attended here?

Church Address

What activities are you involved in?

Church affiliation at school:

Are you involved with any other Christian Organizations?

Director's name and phone number:

Essay Portion:
Please answer the following questions openly and honestly. There are no wrong answers. (OK, there are a few wrong answers, but we've never gotten one.) You can take all the room you need.

Why do you want to work in this ministry?

How and when did you become a Christian?

What knowledge, training, or experience do have that qualifies you for this position?

Explain how you would lead a child to Christ:

What does living a life of Holiness mean to you?

Do you believe it is possible to 're-dedicate' yourself to Christ?

Write your own statement of faith. Take all the room you need.

Describe your devotional time:

Tell us about something God has taught you in the last six months:

Tell us about your experience working with kids:

What do you see as your strengths?

What do you see as your weaknesses?

Activity Experience:
In this section, please use a 1 to indicate the activities that you can organize and teach, meaning that you have considerable experience in them.

Use a 2 to indicate the activities you could assist in.

Use a 3 if you are only slightly familiar.

Use a 4 if you have no idea what this activity is or think we might be making it up.

(You can use a + or - to emphasize your ratings.)

Arts & Crafts


Group Games


Team Building Activities

Lead A Bible Study

Lead a child to Christ

Lead Singing


Skits and Drama


Interacting and having fun with kids


Did we miss anything?

Anything else?

Are there any of these activities that you cannot take part in?

Last, but still really important:

I have read South Side Mission's Statement of Faith and agree with it.

I am willing to wholeheartedly cooperate with the standards of a Christian Day Camp, which include maintaining a positive attitude towards administration and staff, and excludes the use of profanity, smoking, and alcohol.

By submitting this application, you are certifying that all information in this application is true and complete, and that you understand that any misrepresentation of the truth will be cause for immediate dismissal.

After you submit this application, the Youth Department Director will contact you via the e mail you provided. Please check that e mail regularly, and check to see that our contact does not end up in your spam folder.

Thank you for applying to South Side Mission! We look forward to getting to know you!

Attach your resume.